“Speech Pathology Management of Paradoxical Vocal Fold Movement (PVFM) in Asthma” presented by Dr. Anne Vertigan

As part of our ongoing seminar series, the Centre of Excellence in Severe Asthma hosted Dr. Anne Vertigan for a webinar on “Speech Pathology Management of PVFM in Asthma” on 28 July 2015.

Presentation Summary:

Paradoxical vocal fold movement (PVFM) refers to the involuntary adduction of the vocal folds during inspiration. PVFM can contribute to breathlessness. It is also known as vocal cord dysfunction (VCD).

PVFM can be diagnosed by nasendoscopy, hypertonic saline challenge, dynamic CT or based on clinical signs and symptoms. Speech pathology treatment, including breathing exercises, is an effective treatment approach.

Laryngeal abnormalities often occur in asthma, including PVFM, dysphonia and laryngeal hypersensitivity. These conditions may be misdiagnosed as asthma but can also co-occur. When laryngeal dysfunction co-exists, it can contribute to asthma symptoms.

In patients with asthma, laryngeal abnormalities should be considered as alternative diagnoses or as comorbidities. Appropriate treatment of laryngeal abnormalities can improve patient outcomes.

Key Points:

• Laryngeal abnormalities often occur in asthma
• The larynx is important for airway protection (e.g. coughing / swallowing), breathing and phonation
• Paradoxical vocal cord movement (PVFM) is defined as episodic and involuntary adduction of the vocal folds during inspiration
• PVFM leads to dyspnoea, cough, stridor and throat tightness
• PVFM is also known as vocal cord dysfunction (VCD)
• PVFM symptoms can be misdiagnosed as asthma, but can also co-occur with asthma
• Inhaled bronchodilators are not effective treatments for PVFM
• PVFM is diagnosed by nasendoscopy, hypertonic saline challenge, dynamic CT and through clinical signs and symptoms
• Nasendoscopy is considered the gold standard for diagnosis, but is not available in all clinical settings and cannot identify PVFM in asymptomatic periods
• Hypertonic saline challenge and lung function assessment can identify PVFM through a characteristic flattening of the inspiratory portion of the flow volume loops
• Laryngeal dynamic CT is under development for diagnosis
• Clinical history, disparity between lung function testing and symptoms, inspiratory dyspnoea, voice assessment and the coordination of respiratory and phonation can identify PVFM
• Speech pathology treatment includes confirmation of the diagnosis, education, symptom control exercises, reducing laryngeal irritation, counselling and treatment of co-existing laryngeal issues
• PVFM release breathing focusses on releasing tension, abdominal breathing, avoidance of large breaths, avoiding unconscious breath holding, inhalation / exhalation exercises and breathing rhythm
• Distinguishing between asthma and PVFM is important, so that appropriate treatment can be provided for each condition
• Breathing exercises are initially practiced in the clinical setting, then used in asymptomatic periods, before taking asthma medications and then during symptomatic periods outside the clinic or in the presence of known triggers
• Laryngeal irritation can be reduced by avoiding irritants, through desensitisation, hydration and reducing phonotraumatic vocal behaviours
• PVFM and asthma can co-occur or exist in isolation
• Laryngeal problems in asthma can also include dysphonia (difficulty speaking) and laryngeal hypersensitivity
• Laryngeal abnormalities should be considered in patients with asthma

About Dr. Anne Vertigan:

Dr. Anne Vertigan has worked as speech pathologist for Hunter New England Health for over 25 years, with clinical roles including chronic cough, voice disorders and dysphagia.

Her research interests include chronic cough, paradoxical vocal cord movement / vocal cord dysfunction and voice and upper airway problems in asthma.

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